{"id":7488,"date":"2026-10-20T06:00:00","date_gmt":"2026-10-20T06:00:00","guid":{"rendered":"https:\/\/www.belodonte.es\/?p=7488"},"modified":"2026-08-03T09:23:42","modified_gmt":"2026-08-03T09:23:42","slug":"donacio-dorgans-salut-oral-el-que-has-de-saber-si-ets-donant-receptor","status":"publish","type":"post","link":"https:\/\/www.belodonte.es\/ca\/donacio-dorgans-salut-oral-el-que-has-de-saber-si-ets-donant-receptor\/","title":{"rendered":"Donaci\u00f3 d’\u00f2rgans i salut oral: el que has de saber si ets donant o receptor"},"content":{"rendered":"\n

La donaci\u00f3 d’\u00f2rgans <\/strong>\u00e9s un dels actes de solidaritat m\u00e9s impactants que pot realitzar una persona. Espanya \u00e9s l\u00edder mundial en taxes de donaci\u00f3 d’\u00f2rgans per mili\u00f3 d’habitants, amb un model organitzatiu reconegut internacionalment. No obstant aix\u00f2, poques persones coneixen la relaci\u00f3 que existeix entre la salut oral i els processos de donaci\u00f3 i trasplantament d’\u00f2rgans. Aquesta connexi\u00f3 \u00e9s m\u00e9s rellevant del que sembla: l’estat de la cavitat oral pot influir en la viabilitat del trasplantament, en l’\u00e8xit postoperatori i en la salut a llarg termini del receptor.<\/p>\n\n\n\n

Quina relaci\u00f3 existeix entre la salut oral i el trasplantament d’\u00f2rgans?<\/h2>\n\n\n\n

La relaci\u00f3 entre la salut oral i el trasplantament d’\u00f2rgans opera en dues direccions ben diferenciades.<\/p>\n\n\n\n

En el receptor del trasplantament, la immunosupressi\u00f3 farmacol\u00f2gica necess\u00e0ria per a prevenir el rebuig de l’\u00f2rgan trasplantat genera una vulnerabilitat augmentada enfront d’infeccions de tota mena, incloses les d’origen oral. Una infecci\u00f3 odontog\u00e8nica (un absc\u00e9s, una periodontitis activa o una lesi\u00f3 mucosa no tractada) pot convertir-se en una font de bacteri\u00e8mia greu en un pacient inmunosuprimit, amb conseq\u00fc\u00e8ncies potencialment fatals. Per aquest motiu, el sanejament oral complet abans del trasplantament \u00e9s un requisit cl\u00ednic, no una recomanaci\u00f3 opcional.<\/p>\n\n\n\n

En el donant viu (especialment en el trasplantament renal de donant viu), l’estat de salut general, inclosa la salut oral, forma part de l’avaluaci\u00f3 m\u00e8dica pr\u00e8via a la donaci\u00f3, ja que el procediment quir\u00fargic d’extracci\u00f3 requereix anest\u00e8sia general i l’estat periodontal i de la mucosa oral pot afectar el risc infecci\u00f3s peroperatori.<\/p>\n\n\n\n

Quina valoraci\u00f3 oral es realitza abans d’un trasplantament?<\/h2>\n\n\n\n

El protocol de valoraci\u00f3 oral pr\u00e8via al trasplantament varia segons el tipus d’\u00f2rgan i el centre trasplantador, per\u00f2 en tots els casos t\u00e9 el mateix objectiu: identificar i eliminar tots els focus infecciosos actius o potencials abans d’iniciar la immunosupressi\u00f3.<\/p>\n\n\n\n

La valoraci\u00f3 inclou una exploraci\u00f3 oral completa amb ortopantomografia per a detectar c\u00e0ries profundes, lesions periapicals, malaltia periodontal activa, dents amb pron\u00f2stic no recuperable i lesions de la mucosa que requereixin estudi. Tamb\u00e9 es valoren les pr\u00f2tesis amovibles en mal estat que puguin generar irritaci\u00f3 cr\u00f2nica o servir de reservori bacteri\u00e0.<\/p>\n\n\n\n

El sanejament oral pretrasplant ha de completar-se almenys quatre setmanes abans de la data prevista de trasplantament, per a permetre la cicatritzaci\u00f3 completa de les ferides quir\u00fargiques abans d’iniciar la immunosupressi\u00f3. En casos d’urg\u00e8ncia (trasplantament de donant cad\u00e0ver amb temps d’espera impredictible), el sanejament ha de realitzar-se amb la m\u00e0xima rapidesa possible, prioritzant els focus de risc infecci\u00f3s m\u00e9s elevat.<\/p>\n\n\n\n

Com afecta la immunosupressi\u00f3 posttrasplantament a la salut oral?<\/h2>\n\n\n\n

La immunosupressi\u00f3 farmacol\u00f2gica posttrasplantament genera un conjunt de canvis en la cavitat oral que requereixen un seguiment espec\u00edfic i actiu a llarg termini.<\/p>\n\n\n\n

La hiperpl\u00e0sia gingival \u00e9s un dels efectes secundaris m\u00e9s freq\u00fcents i visibles. La ciclosporina A, un dels immunosupressors m\u00e9s utilitzats, provoca un creixement exagerat del teixit gingival en m\u00e9s del 30% dels pacients que la reben, generant bosses pseudoperiodontal que dificulten la higiene i augmenten el risc d’infecci\u00f3. El tacrolim\u00fas, que ha substitu\u00eft a la ciclosporina en molts protocols actuals, t\u00e9 menor incid\u00e8ncia d’hiperpl\u00e0sia gingival.<\/p>\n\n\n\n

Les infeccions oportunistes s\u00f3n especialment freq\u00fcents i potencialment greus en el pacient trasplantat. La candidiasi oral (per Candida albicans) \u00e9s la m\u00e9s habitual i pot estendre’s a l’orofaringe i l’es\u00f2fag si no es tracta. Les reactivacions del virus herpes simple (herpes oral recurrent) i del virus d’Epstein-Barr (amb potencial de generar lesions limfoproliferatives en la mucosa oral) s\u00f3n altres manifestacions infeccioses que requereixen vigil\u00e0ncia activa.<\/p>\n\n\n\n

El risc de c\u00e0ncer oral augmenta de manera significativa en els trasplantats de llarga evoluci\u00f3, especialment el carcinoma epidermoide oral i el carcinoma de llavi, relacionat amb la immunosupressi\u00f3 cr\u00f2nica i la reactivaci\u00f3 viral.<\/p>\n\n\n\n

Amb quina freq\u00fc\u00e8ncia ha de revisar-se la salut oral del pacient trasplantat?<\/h2>\n\n\n\n

El pacient trasplantat \u00e9s un pacient d’alt risc oral que requereix un seguiment m\u00e9s estret que la poblaci\u00f3 general.<\/p>\n\n\n\n

Durant el primer any posttrasplantament, les revisions orals cada tres mesos permeten monitorar l’aparici\u00f3 de complicacions associades a la immunosupressi\u00f3 i tractar preco\u00e7ment qualsevol infecci\u00f3 abans que es propagui.<\/p>\n\n\n\n

A partir del primer any, quan la immunosupressi\u00f3 sol haver-se estabilitzat en dosi de manteniment, la freq\u00fc\u00e8ncia pot espaiar-se a revisions cada quatre a sis mesos, sempre en funci\u00f3 de l’estat cl\u00ednic del pacient i del tipus d’immunosupressor utilitzat.<\/p>\n\n\n\n

L’exploraci\u00f3 mucosa sistem\u00e0tica en cada visita \u00e9s imprescindible per a la detecci\u00f3 preco\u00e7 de lesions premalignes o malignes, la incid\u00e8ncia de les quals \u00e9s significativament major en trasplantats que en la poblaci\u00f3 general.<\/p>\n\n\n\n

Quines precaucions espec\u00edfiques requereix la cirurgia oral en el pacient trasplantat?<\/h2>\n\n\n\n

La cirurgia oral en el pacient trasplantat \u00e9s un procediment de risc m\u00e9s alt que en la poblaci\u00f3 general, i requereix una planificaci\u00f3 acurada i una coordinaci\u00f3 estreta amb l’equip de trasplantament.<\/p>\n\n\n\n

El risc infecci\u00f3s augmentat exigeix una profilaxi antibi\u00f2tica sistem\u00e0tica abans de qualsevol procediment invasiu, amb elecci\u00f3 de l’antibi\u00f2tic ajustada a les possibles interaccions amb els immunosupressors del pacient.<\/p>\n\n\n\n

El risc hemorr\u00e0gic pot estar augmentat en pacients amb trombocitop\u00e8nia (freq\u00fcent en trasplantats renals i hep\u00e0tics) o en tractament amb anticoagulants.<\/p>\n\n\n\n

La funci\u00f3 renal o hep\u00e0tica de l’\u00f2rgan trasplantat determina la farmacocin\u00e8tica dels anest\u00e8sics, analg\u00e8sics i antibi\u00f2tics utilitzats en el procediment, i ha de valorar-se abans de qualsevol prescripci\u00f3.<\/p>\n\n\n\n

I les interaccions farmacol\u00f2giques entre els immunosupressors i els f\u00e0rmacs d’\u00fas odontol\u00f2gic s\u00f3n nombroses i cl\u00ednicament rellevants: el fluconazole (antif\u00fangic d’\u00fas freq\u00fcent en odontologia) augmenta de manera significativa els nivells plasm\u00e0tics de tacrolim\u00fas i ciclosporina, amb el risc de toxicitat. La consulta sistem\u00e0tica de la base de dades d’interaccions abans de qualsevol prescripci\u00f3 \u00e9s una pr\u00e0ctica imprescindible en aquest context.<\/p>\n\n\n\n

Quin paper t\u00e9 el cirurgi\u00e0 maxil\u00b7lofacial en el seguiment del trasplantat?<\/h2>\n\n\n\n

El cirurgi\u00e0 maxil\u00b7lofacial i l’especialista en medicina oral s\u00f3n els professionals de refer\u00e8ncia per al seguiment oral a llarg termini del pacient trasplantat. El seu paper inclou la detecci\u00f3 i tractament de la hiperpl\u00e0sia gingival severa (que pot requerir gingivectomia quir\u00fargica quan compromet la higiene o la funci\u00f3), la bi\u00f2psia i diagn\u00f2stic de lesions mucoses sospitoses, el tractament de les complicacions infeccioses orals greus i la coordinaci\u00f3 amb l’equip de trasplantament per a la gesti\u00f3 segura de qualsevol intervenci\u00f3 quir\u00fargica oral que el pacient requereixi al llarg del seu seguiment.<\/p>\n\n\n\n

Preguntes freq\u00fcents sobre donaci\u00f3 d’\u00f2rgans i salut oral<\/h2>\n\n\n\n

Puc ser donant d’\u00f2rgans si tinc malaltia periodontal?<\/h3>\n\n\n\n

La malaltia periodontal per si sola no \u00e9s una contraindicaci\u00f3 per a la donaci\u00f3 d’\u00f2rgans. L’avaluaci\u00f3 de la idone\u00eftat del donant se centra en la salut dels \u00f2rgans a donar i en l’abs\u00e8ncia de malalties transmissibles o tumors malignes. No obstant aix\u00f2, en el cas del donant viu, l’estat de salut general, inclosa la salut oral, forma part de la valoraci\u00f3 m\u00e8dica preoperat\u00f2ria.<\/p>\n\n\n\n

Quant temps abans del trasplantament ha de completar-se el sanejament oral?<\/h3>\n\n\n\n

Idealment, almenys quatre setmanes abans de la data prevista de trasplantament, per a garantir la cicatritzaci\u00f3 completa de les ferides quir\u00fargiques abans de l’inici de la immunosupressi\u00f3. En situacions d’urg\u00e8ncia, el sanejament ha de prioritzar-se i completar-se en el menor temps possible, amb especial atenci\u00f3 als focus de risc infecci\u00f3s m\u00e9s elevat.<\/p>\n\n\n\n

Puc posar-me implants dentals despr\u00e9s d’un trasplantament?<\/h3>\n\n\n\n

S\u00ed, encara que amb consideracions espec\u00edfiques. Els implants dentals en pacients trasplantats s\u00f3n factibles i tenen taxes de superviv\u00e8ncia acceptables quan la immunosupressi\u00f3 est\u00e0 estabilitzada i l’estat de salut general \u00e9s adequat. La coordinaci\u00f3 amb l’equip de trasplantament \u00e9s imprescindible abans de planificar qualsevol procediment implantol\u00f2gic en aquest context.<\/p>\n\n\n\n

Per qu\u00e8 augmenta el risc de c\u00e0ncer oral en els trasplantats?<\/h3>\n\n\n\n

La immunosupressi\u00f3 cr\u00f2nica redueix la capacitat del sistema immunitari per a vigilar i eliminar les c\u00e8l\u00b7lules amb alteracions gen\u00e8tiques premalignes, i facilita la reactivaci\u00f3 de virus oncog\u00e8nics com el virus del papil\u00b7loma hum\u00e0 (VPH) i el virus d’Epstein-Barr. Aquest doble mecanisme explica l’augment significatiu de la incid\u00e8ncia de carcinoma oral i altres tumors en els pacients trasplantats a llarg termini.<\/p>\n\n\n\n

Si est\u00e0s en llista d’espera per a un trasplantament o n’acabes de rebre un, no oblidis incloure la salut oral en el teu seguiment m\u00e8dic. Una revisi\u00f3 especialitzada abans i despr\u00e9s del trasplantament pot marcar una difer\u00e8ncia real en la teva seguretat i en l’\u00e8xit del procediment.<\/p>\n","protected":false},"excerpt":{"rendered":"

La donaci\u00f3 d’\u00f2rgans \u00e9s un dels actes de solidaritat m\u00e9s impactants que pot realitzar una persona. Espanya \u00e9s l\u00edder mundial en taxes de donaci\u00f3 d’\u00f2rgans per mili\u00f3 d’habitants, amb un model organitzatiu reconegut internacionalment. No obstant aix\u00f2, poques persones coneixen […]<\/p>\n","protected":false},"author":3,"featured_media":7487,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[36],"tags":[],"class_list":["post-7488","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-odontologia-conservadora-2"],"yoast_head":"\nDonaci\u00f3 d'\u00f2rgans i salut oral: el que has de saber si ets donant o receptor<\/title>\n<meta name=\"description\" content=\"La donaci\u00f3 d'\u00f2rgans i la salut oral estan m\u00e9s relacionades del que moltes persones imaginen. 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